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Lpn Utilization Management Jobs (NOW HIRING)

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... Successful candidates must hold a valid, current license issued by the Massachusetts Board of ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... Successful candidates must hold a valid, current license issued by the Massachusetts Board of ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... Successful candidates must hold a valid, current license issued by the Massachusetts Board of ...

HealthCheck360

Utilization Management Assistant

Dubuque, IA

$39K - $45K/yr

Utilization Management Assistant Location : Onsite in Dubuque, IA. Also accepting remote applicants ... LPN, CNA, Medical Assistants, or individuals with a background in customer service who are looking ...

HealthCheck360

Utilization Management Assistant

Dubuque, IA · On-site

$39K - $45K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Management Assistant Location : Onsite in Dubuque, IA. Also accepting remote applicants ... LPN, CNA, Medical Assistants, or individuals with a background in customer service who are looking ...

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

Current licensure as a Registered Nurse (RN) as issued by the State of Tennessee. CCM/CPHQ certification preferred or equivalent expertise in area of Utilization Management as evidenced by ...

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Lpn Utilization Management information

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How much do lpn utilization management jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for lpn utilization management in the United States is $29.88, according to ZipRecruiter salary data. Most workers in this role earn between $24.76 and $33.65 per hour, depending on experience, location, and employer.

What is an LPN Utilization Management nurse?

An LPN Utilization Management nurse is a Licensed Practical Nurse who works within the healthcare system to review and evaluate the necessity, appropriateness, and efficiency of healthcare services and treatments. Their primary role is to help ensure patients receive the right care while managing healthcare costs and resources effectively. They often work with insurance companies, hospitals, or clinics, collaborating with other healthcare professionals to make determinations about coverage and care plans. This position requires strong analytical skills, communication abilities, and a solid understanding of medical guidelines and regulations.

What is the difference between Lpn Utilization Management vs Lpn Case Management?

AspectLpn Utilization ManagementLpn Case Management
CertificationsLicensed Practical Nurse (LPN)Licensed Practical Nurse (LPN)
Work EnvironmentInsurance companies, utilization review departmentsHospitals, clinics, community health settings
Primary FocusReviewing medical necessity and insurance coverageCoordinating patient care and discharge planning
Employer & Industry UsageInsurance providers, managed care organizationsHealthcare facilities, outpatient clinics

While both roles require an LPN license, Lpn Utilization Management focuses on reviewing medical necessity for insurance purposes, whereas Lpn Case Management emphasizes coordinating patient care and discharge planning. Understanding these differences helps in choosing the right career path or job search focus within healthcare.

What are the key skills and qualifications needed to thrive as an LPN Utilization Management nurse?

To thrive as an LPN Utilization Management Nurse, you need a current LPN license, strong clinical knowledge, and experience in care coordination or case management. Familiarity with utilization review software, electronic health records (EHRs), and compliance tools is often required, along with knowledge of insurance and regulatory guidelines. Excellent communication, critical thinking, and organizational skills are crucial for collaborating with healthcare teams and advocating for patients. These skills ensure effective resource utilization, regulatory compliance, and high-quality patient outcomes.

What are some common challenges LPNs face in utilization management roles, and how can they be addressed?

LPNs in Utilization Management often encounter challenges such as interpreting complex medical records, balancing administrative tasks with clinical judgment, and keeping up with evolving insurance guidelines. To address these, it's helpful to develop strong attention to detail, stay current with payer requirements, and seek mentorship or ongoing training in medical coding and documentation. Collaboration with RNs, physicians, and case managers is key to overcoming these hurdles and ensuring accurate, efficient patient care assessments.
More about Lpn Utilization Management jobs

What cities are hiring for Lpn Utilization Management jobs?

Cities with the most Lpn Utilization Management job openings:

What states have the most Lpn Utilization Management jobs?

States with the most job openings for Lpn Utilization Management jobs include:

What job categories do people searching Lpn Utilization Management jobs look for?

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Lpn Utilization Management jobs near you
Infographic showing various Lpn Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $62,140 per year, or $29.9 per hour.

RN - Utilization Management

Central Business Solutions

Milford, NH • On-site

Other

Re-posted 16 days ago

Job description

Utilization Management Registered Nurse (UM RN)

We are seeking an experienced and detail-oriented Utilization Management Registered Nurse (UM RN) to join our hospital team. The UM RN is responsible for reviewing patient cases to ensure appropriate utilization of healthcare services, medical necessity, compliance with payer requirements, and optimal patient outcomes. This role collaborates closely with physicians, case managers, and interdisciplinary teams to support quality patient care while managing healthcare resources efficiently.

Key Responsibilities
  • Perform utilization review activities for inpatient and outpatient services.
  • Assess medical necessity, level of care, and appropriateness of admissions using established criteria such as InterQual or MCG guidelines.
  • Collaborate with physicians, case management, and healthcare teams regarding patient care plans and discharge planning.
  • Communicate with insurance providers and third-party payers to obtain authorizations and resolve coverage issues.
  • Monitor patient length of stay and identify opportunities to improve care efficiency.
  • Ensure compliance with hospital policies, federal regulations, and payer requirements.
  • Document utilization review findings accurately and maintain confidentiality of patient information.
  • Participate in denial prevention and appeals processes when necessary.
  • Support quality improvement initiatives and patient care coordination activities.
Qualifications
  • Active Registered Nurse (RN) license in the applicable state.
  • Bachelor of Science in Nursing (BSN) preferred.
  • Minimum 2–3 years of acute care hospital nursing experience required.
  • Prior experience in Utilization Management, Case Management, or Care Coordination preferred.
  • Strong knowledge of InterQual and/or MCG criteria.
  • Experience working with electronic medical records (EMR) systems.
  • Excellent communication, critical thinking, and organizational skills.

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